American advocates for youth gender medicine have insisted for years that overwhelming evidence favors providing gender dysphoric youth with puberty blockers, hormones and, in the case of biological females, surgery to remove their breasts.
It didn’t matter that the number of kids showing up at gender clinics had soared and that they were more likely to have complex mental health conditions than those who had come to clinics in years earlier, complicating diagnosis. Advocates and health care organizations just dug in. As a billboard truck used by the L.G.B.T.Q. advocacy group GLAAD proclaimed in 2023, “The science is settled.” The Human Rights Campaign says on its website that “the safety and efficacy of gender-affirming care for transgender and nonbinary youth and adults is clear.” Elsewhere, these and other groups, like the American Civil Liberties Union, referred to these treatments as “medically necessary,” “lifesaving” and “evidence-based.”
The reason these advocates were able to make such strong statements is that for years, the most important professional medical and mental health organizations in the country had been singing a similar tune: “The science” was supposedly codified in documents published by these organizations. As GLAAD puts it on its website, “Every major medical association supports health care for transgender people and youth as safe and lifesaving.”
But something confounding has happened in the last few weeks: Cracks have appeared in the supposed wall of consensus.
After expressing concerns about the evidence base in 2024, on Feb. 3, the American Society of Plastic Surgeons became the first major American medical group to publicly question youth gender medicine since its widespread adoption. The organization published a nine-page “position statement” advising its members against any gender-related surgeries before age 19 and noting that “there are currently no validated methods” for determining whether youth gender dysphoria will resolve without medical treatment. (The document also acknowledged a similar level of uncertainty surrounding blockers and hormones, though that’s less directly relevant to the practice of plastic surgeons.)
The next day, the American Medical Association — which has long approved of such procedures — announced that “in the absence of clear evidence, the A.M.A. agrees with A.S.P.S. that surgical interventions in minors should be generally deferred to adulthood.”
These statements were released days after a woman named Fox Varian became the first person to win a malpractice case after undergoing gender transition care and later regretting it. Ms. Varian and her lawyer argued that her psychologist and plastic surgeon in suburban New York, despite her serious mental health problems and apparent ambivalence over her transgender identity, failed to safeguard her by going forward with a double mastectomy when she was 16. (Many gender medicine practitioners and advocates believe that to carefully scrutinize or even explore claims of a transgender identity is to engage in de facto conversion therapy.) The jury’s $2 million award will most likely give pause to hospitals and clinics that continue to provide these treatments without substantial guardrails.
Read the rest here.
